Maternal and Child Health Commons^™

Community Health Workers And The Media Can Be Effective In Providing Health Information To Married Adolescent Girls In The Community, Population Council

Reproductive Health

Past research has found that married adolescent girls in Nyanza Province, Kenya, face higher risks of HIV infection than unmarried but sexually active girls their age in the province and other parts of the country. To address this challenge, the Population Council’s APHIA II Operations Research Project, in collaboration with Well Told Story and the Ministry of Public Health and Sanitation, developed a study to assess the effectiveness of an intervention designed to increase married adolescent girls’ access to comprehensive reproductive health and HIV information and services in Homa Bay and Rachuonyo districts. The study found that using interactive communication …

A Pay-For-Performance Innovation Integrating The Quantity And Quality Of Care In Maternal, Newborn And Child Health Services In Bangladesh, Laila Rahman, Ubaidur Rob, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Md. Noorunnabi Talukder, Md. Hafizur Rahman

Reproductive Health

The Population Council explored the possibilities of introducing a Pay-for-Performance (P4P) scheme in Bangladesh to improve maternal, newborn and child healthcare (MNCH) services. Based on the consultation and with guidance from the Government of Bangladesh, the Population Council and UNICEF provided technical assistance to the Directorate General of Health Services (DGHS) to test two P4P strategies for MNCH service providers to improve service volume and quality of care, and for poor clients to receive services subsidized through vouchers or coupons. The first strategy is a combination of pay-for-performance for providers and subsidized coupons for poor pregnant women, newborns, and under-five …

Levels, Trends And Determinants Of Contraceptive Use Among Adolescent Girls In Kenya, Francis Obare, Harriet Birungi, Chi-Chi Undie, Monica Wanjiru, Wilson Liambila, Ian Askew

Reproductive Health

In Kenya, recent trends in contraceptive use among currently married women aged 15–49 years show that after experiencing a stall between 1998 and 2003, the contraceptive prevalence rate (CPR) increased between 2003 and 2008–2009. Although the increase in CPR after 2003 is encouraging, there is limited understanding of how these changes affected adolescents, especially girls, given the unique sexual and reproductive health challenges that they face. This report is based on a secondary analysis of the Kenya Demographic and Health Surveys (KDHS) data to understand the trends, differentials, and determinants of contraceptive use among adolescent girls aged 15–19 years in …

Integrating Tuberculosis Case Finding And Treatment Into Postnatal Care, Charity Ndwiga, Harriet Birungi, Chi-Chi Undie, Shiphrah Kuria, Joseph Sitienei, Sam Ochola

Reproductive Health

Under the USAID funded FRONTIERS program, the Population Council conducted a study in six health facilities in Western Kenya that demonstrated that screening for TB within an antenatal care (ANC) setting is feasible and acceptable among the service providers. However, a major challenge remains: although TB detection is encouraged among ANC clients within the maternal and child health clinics in the country, providers in these settings fail to appreciate the need for a continuum of care from pregnancy through to the postnatal period. In order to address this gap, the APHIA II Operations Research Project developed and tested an intervention …

Making Hiv Services More Responsive To Young Children And Infants In Nyanza, Monica Wanjiru

Reproductive Health

Health workers in Kenya often miss opportunities to discuss pediatric HIV with clients and to track exposed children in order to initiate treatment. To address this problem, the Population Council’s APHIA II Operations Research Project collaborated with the Christian Health Association of Kenya, Catholic Relief Services, and the Kendu Adventist Hospital to improve HIV testing and treatment services for children at the hospital. The project recommended that pediatric HIV services be strengthened and included as an essential service at all levels of healthcare facilities in order to reach more children, including as one of the roles of the community health …

Operationalizing And Scaling Up Hiv/Rh Referrals In Kenya: The Way Forward, Aphia Ii Or Project In Kenya

Reproductive Health

This policy brief describes the APHIA II Operations Research Project through which the Population Council and Kenya’s Ministry of Health (MOH) developed and tested an approach to systematically link HIV-positive family planning (FP) clients to treatment and care services. Key activities included provider training and testing of a referral package which showed how, where, when, and who is to make and receive referrals. This referral package consisted of a directory listing all facilities in the vicinity available for services including HIV counseling and testing, FP, STIs, tuberculosis, and well-child checks; and referral forms directing clients to appropriate receiving clinics. The …

Service Improvements And Community Education Lead To Increase In Uptake Of Hiv Services For Infants And Young Children, Population Council

Reproductive Health

The Population Council’s APHIA II Operations Research Project in Kenya collaborated with Kendu Adventist Hospital and the Christian Health Association to launch a study to examine the effect of improved services and awareness-creation on the uptake of HIV testing and treatment services for children and infants exposed to HIV. The study showed that community education and improvements in individual case tracking can increase the proportion of infants exposed to HIV who are tested for HIV and put on appropriate treatment. The policy brief recommends that health facilities streamline services to ensure that as many exposed infants as possible are identified …

Increasing Access To Family Planning (Fp) And Reproductive Health (Rh) Services Through Task-Sharing Between Community Health Workers (Chws) And Community Mid-Level Professionals In Large-Scale Public-Sector Programs: A Literature Review To Help Guide Case Studies, James R. Foreit, Sarah Raifman

Reproductive Health

This literature review covers case studies related to community-based distribution of family planning programs, and community health worker (CHW) programs that included family planning and other reproductive health services. It offers essential processes and implications for additional operations research which look at constraints and factors critical to introducing new program procedures or strengthening existing ones.

Informe Años Dos Movil.Com: Evaluación De La Línea Final Resumen De Hallazgos Principales, Annik Sorhaindo, Xipatl Contreras, Kate S. Wilson, Sandra G. Garcia

Reproductive Health

This report highlights the findings of the endline evaluation of a two-year leadership project aimed at indigenous youth in Oaxaca, Mexico: Movil.com. Movil.com is a community project headed by peers and built on elements of other models. It is similar to a cascaded peer education and training model, in which nuclear leaders are trained who, in turn, train facilitators of larger groups. The Population Council office in Mexico evaluated the project at the request of the social organization that implements it, the Rosales Castellanos Women's Study Group, an NGO that has worked for more than 30 years with indigenous communities …

The Effect Of Female Education On Fertility And Infant Health: Evidence From School Entry Policies Using Exact Date Of Birth, Justin Mccrary, Heather Royer

Faculty Scholarship

This paper uses age-at-school-entry policies to identify the effect of female education on fertility and infant health. We focus on sharp contrasts in schooling, fertility, and infant health between women born just before and after the school entry date. School entry policies affect female education and the quality of a woman’s mate and have generally small, but possibly heterogeneous, effects on fertility and infant health. We argue that school entry policies manipulate primarily the education of young women at risk of dropping out of school.

Aplastic Anemia: Clinicohaematological Features, Treatment And Outcome Analysis, Rabia Wali, Zehra Fidoo, Salman Adil, Muhammad Ahmed Naqvi

Department of Pathology and Laboratory Medicine

Objective: To determine the clinicohaematological features, treatment and outcome of children diagnosed with aplastic anemia at a single institution.

Study Design: Observational study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 1999 till December 2008.

Methodology: Medical records of children aged less than 15 years of age diagnosed with aplastic anemia were reviewed. Clinicohaematological features, treatment and its response to therapy and outcome were recorded. Results were described in percentages.

Results: Ninety patients were diagnosed to have aplastic anemia (AA); 65 were male during the study period. Age ranged from 1 to 15 years. Fever …

Maternal Defense: Breastfeeding Heightens Aggression By Reducing Stress, Jennifer Hahn-Holbrook, Julianne Holt-Lunstad, Colin Holbrook, Sarah M. Coyne, E. Thomas Lawson

Psychology Faculty Articles and Research

Mothers in numerous species exhibit heightened aggression in defense of their young. This shift typically coincides with the duration of lactation in nonhuman mammals, which suggests that human mothers may display similarly accentuated aggressiveness while breast feeding. Here we report the first behavioral evidence for heightened aggression in lactating humans. Breast-feeding mothers inflicted louder and longer punitive sound bursts on unduly aggressive confederates than did formula-feeding mothers or women who had never been pregnant. Maternal aggression in other mammals is thought to be facilitated by the buffering effect of lactation on stress responses. Consistent with the animal literature, our results …

Prenatal Maternal Stress Programs Infant Stress Regulation, Elyssia Poggi Davis, Laura M. Glynn, Feizal Waffarn, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: Prenatal exposure to inappropriate levels of glucocorticoids (GCs) and maternal stress are putative mechanisms for the fetal programming of later health outcomes. The current investigation examined the influence of prenatal maternal cortisol and maternal psychosocial stress on infant physiological and behavioral responses to stress.

Methods: The study sample comprised 116 women and their full term infants. Maternal plasma cortisol and report of stress, anxiety and depression were assessed at 15, 19, 25, 31 and 36 + weeks' gestational age. Infant cortisol and behavioral responses to the painful stress of a heel-stick blood draw were evaluated at 24 hours after …

Prenatal Programming Of Human Neurological Function, Curt A. Sandman, Elyssia Poggi Davis, Claudia Buss, Laura M. Glynn

Psychology Faculty Articles and Research

The human placenta expresses the genes for proopiomelanocortin and the major stress hormone, corticotropin-releasing hormone (CRH), profoundly altering the "fight or flight" stress system in mother and fetus. As pregnancy progresses, the levels of these stress hormones, including maternal cortisol, increase dramatically. These endocrine changes are important for fetal maturation, but if the levels are altered (e.g., in response to stress), they influence (program) the fetal nervous system with long-term consequences. The evidence indicates that fetal exposure to elevated levels of stress hormones (i) delays fetal nervous system maturation, (ii) restricts the neuromuscular development and alters the stress response of …

Maternal Exposure To The Holocaust And Health Complaints In Offspring, Janine D. Flory, Linda M. Bierer, Rachel Yehuda

Publications and Research

Although the link between chronic stress and the development of cardiovascular and metabolic diseases of adulthood has been known for some time, there is growing recognition that early environmental influences may result in developmental programming via epigenetic mechanisms, thereby affecting the developmental trajectory of disease progression. Previous studies support the idea that offspring of Holocaust survivors may have been subjected to early developmental programming. We evaluated the relationship between parental exposure to the Holocaust and selfreported health ratings and disorders made by their adult offspring (i.e., second generation Holocaust survivors). A total of 137 subjects were evaluated. Regression analyses demonstrated …

Development Of Fetal Movement Between 26 And 36 Weeks’ Gestation In Response To Vibroacoustic Stimulation, Marybeth Grant-Beuttler, Laura M. Glynn, Amy L. Salisbury, Elyssia Poggi Davis, Carol Holliday, Curt A. Sandman

Psychology Faculty Articles and Research

BACKGROUND: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation.

AIM: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response).

DESIGN: A prospective, longitudinal design was utilized.

SUBJECTS: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging.

OUTCOME MEASURES: …

Perceptions Of Maternal Stress And Neonatal Patient Outcomes In A Single Private Room Versus Open Room Neonatal Intensive Care Unit Environment., Lisa M. Smithgall

Electronic Theses and Dissertations

Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in …

Communities, Birth Attendants And Health Facilities: A Continuum Of Emergency Maternal And Newborn Care (The Global Network's Emonc Trial), Omrana Pasha, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Fernando Althabe, Archana Patel, Fabian Esamai, Ana Garces, Elwyn Chomba, Manolo Mazariegos, Bhala Kodkany, Jose M. Belizan, Richard J. Derman, Patricia L. Hibberd, Waldemar A. Carlo, Edward A. Liechty, K. Michael Hambidge, Pierre Buekens, Dennis Wallace, Lisa Howard-Grabman, Suzanne Stalls, Marion Koso-Thomas, Alan H. Jobe, Linda L. Wright

Community Health Sciences

Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and …

Community-Based Intervention Packages For Reducing Maternal And Neonatal Morbidity And Mortality And Improving Neonatal Outcomes, Zohra S. Lassi, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as tetanus toxoid immunisation to mothers, clean and skilled care at delivery, newborn resuscitation, exclusive breastfeeding, clean umbilical cord care, management of infections in newborns, many require facility based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be …

A Qualitative Study Of Coping In Mothers Of Children With An Autism Spectrum Disorder, Heather Miller Kuhaneck, Tajhma Burroughs, Jamie Wright, Theresa Lemanczyk, Amy Rowntree Darragh

Occupational Therapy Faculty Publications

A significant body of research exists that explores the stressors of raising a child with an autism spectrum disorder (ASD). There are fewer studies, however, that examine specific effective coping strategies of mothers of children with an ASD. This qualitative study explored mothers’ perceptions of effective coping strategies for their parenting stressors. In-depth interviews were conducted with 11 mothers to inquire about their personal coping methods. Interviews were coded and emergent themes identified which included coping strategies such as “me time,” “planning,” “knowledge is power,” “sharing the load,” “lifting the restraints of labels,” and “recognizing the joys.” The information from …

El Papel De La Educación Y Las Ong’S En Mejorar El Acceso A Derechos Para Inmigrantes: El Caso De Los Derechos Sexuales Y Reproductivos = The Role Of Education And Ngo’S In Helping Immigrants Obtain Better Access To Their Rights: The Specific Case Of Sexual And Reproductive Rights, Amy Torres

Independent Study Project (ISP) Collection

In January of 2004, Argentina approved a new immigration law that guaranteed the protection of human rights for all immigrants in the country regardless of their legal status with the State. Among the rights explicitly guaranteed by this law were the right to migrate, the right to education and the right to health care. While this law represents a significant advance by the Argentine government in protecting the human rights of immigrants, oppressive mechanisms still remain in everyday practices that inhibit actual access to their rights.

Considering the changes in the law and the breach between the laws and everyday …

Midwives, Rain, And Donkey Carts: Factors Affecting Women’S Decisions To Deliver At Home Or At A Clinic In Rural Mali, Jessica Preslar

Independent Study Project (ISP) Collection

This study focuses on this complex array of factors that affect women’s decisions or abilities to go to a local clinic, a Centre de Santé Communitaire (CSCOM), to give birth. The influence of money, distance from a CSCOM, and beliefs about the CSCOM and modern medicine are all investigated, as well as an open discussion about the decision and ability surrounding place of delivery.Both qualitative and quantitative data is gathered through interviews regarding these factors to allow for a broad range of data analysis; interviews are used to communicate directly with the women, and to obtain a more thorough understanding …

Regional Collaborations As A Way Forward For Maternal, Newborn And Child Health:The South Asian Healthcare Professional Workshop, Jennifer H. Requejo, Kadidiatou Toure, Zulfiqar Ahmed Bhutta, Imtiaz Katz, Shahida Zaidi, Andres De Francisco

Woman and Child Health

This article reviews the importance of regional initiatives in the context of global efforts to achieve the Millennium Development Goal 4 and 5 and describes the action-oriented multi-country healthcare professional association (HCPA) workshops organized by the Partnership for Maternal, Newborn and Child Health. The South Asian HCPA workshop served as a catalyst for strengthening the ability of HCPAs in South Asian countries to organize and coordinate their activities effectively, play a larger role in national planning, and collaborate with other key stakeholders in maternal, newborn and child health.

Education As A Detour On The Path To Inevitable Motherhood: The Acquired Values And Collective Ambitions Of The Students At La Maison D’Education Mariama Ba, Hannah Deangelis

Independent Study Project (ISP) Collection

The values young Senegalese women acquire at home revolve around motherhood, domesticity and, above all, solidarity. The students lucky enough to attend La Maison D’Education Mariama Ba, the most elite girl’s high school in all of Senegal carry these community-centered values. Here, young Senegalese women have a chance to take a detour from the prescribed path that their gender has dictated by spending seven years living and studying with their peers in a highly intellectual setting. An understanding of the narratives of their lives before school, time spent at MEMB, and vision of their futures provides a lens through which …

Reasons For Reducing Breastfeeding Duration Among Chinese Mothers In Ireland:A Qualitative Study, Qianling Zhou

Other resources

Introduction: The Ireland Chinese Mother Survey has revealed a remarkable decline of breastfeeding duration among Chinese mothers who gave birth in Ireland [1]. This qualitative study was undertaken to explore the reasons for such a decrease and to determine the influence of residency in Ireland on breastfeeding practices among immigrant Chinese. Methods: Purposive sampling together with the snowball technique was used to recruit immigrant Chinese women who have given birth in Ireland. Seven focus groups were conducted and thematic content analysis was performed to analyse the data. Results: Decline in breastfeeding duration was not mainly due to the formula feeding …

Primary Human Mammary Epithelial Cells Endocytose Hiv-1 And Facilitate Viral Infection Of Cd4+ T Lymphocytes, Stephanie M. Dorosko, Ruth I. Connor

Dartmouth Scholarship

The contribution of mammary epithelial cells (MEC) to human immunodeficiency virus type 1 (HIV-1) in breast milk remains largely unknown. While breast milk contains CD4(+) cells throughout the breast-feeding period, it is not known whether MEC directly support HIV-1 infection or facilitate infection of CD4(+) cells in the breast compartment. This study evaluated primary human MEC for direct infection with HIV-1 and for indirect transfer of infection to CD4(+) target cells. Primary human MEC were isolated and assessed for expression of HIV-1 receptors. MEC were exposed to CCR5-, CXCR4- and dual-tropic strains of HIV-1 and evaluated for viral reverse transcription …

2009 Annual Report Of Child Deaths In Clark County, Nevada, Nevada Institute For Children’S Research And Policy

Nevada Institute for Children's Research and Policy Reports

In an effort to identify risk factors and prevent future child deaths, in 1992 the State of Nevada joined many other states in mandating Child Death Review Teams. Since that time, both the law and the regional teams throughout Nevada have evolved to facilitate the growing need for collaborative efforts to identify interventions necessary to reduce the rate of child deaths in Nevada. While the primary legislative focus of Nevada Child Death Review Teams has been on addressing fatalities related to child maltreatment and/or involvement with the child welfare system, the teams have expanded their focus to address risk factors …

The Relationship Between Breastfeeding And Child Care For Working Mothers In The United States, Patricia Wonch Hill

Department of Sociology: Dissertations, Theses, and Student Research

Whether or not child care provider characteristics and factors related to the care giving environment impact breastfeeding duration for working mothers has not been systematically studied. In this dissertation, I use Ecological Health Promotion Theory to explore the relationship between child care and breastfeeding through three different analyses. First, I interviewed nine child care providers to assess their knowledge, attitudes and beliefs about infant feeding and whether they vary on these factors across individuals and child care licensing types. Second, I conducted a small mail survey of 93 licensed child care providers in order to create a scale measuring attitudes …

Early Childhood Care And Education For All In 2015: Is This A Mirage In Nigeria?, Esther A. Oduolowu

Journal of Global Initiatives: Policy, Pedagogy, Perspective

This paper examines the possibility of the provision of Early Childhood Care and Education (ECCE) for all children from birth to age five in Nigeria by 2015. In the paper are the history of preschool education in Nigeria) situation of ECCE worldwide in the 1980s) and the, global trends in basic education in the 1990s. The paper also examines the limitations of the attempt and offers probable solutions.

Forced Migration And The Survival Needs Of The Nigerian Child, Ngozi Diwunma Obidike

Journal of Global Initiatives: Policy, Pedagogy, Perspective

This article identifies the survival needs of the forced migrant Nigerian child as well as the extent to which the identified needs are satisfied. The population consisted of 600 forced migrant children and 10 emergency workers who were chosen based on their experiences being forced migrants. A questionnaire was used for the study. The result showed) among other things, that although the need for food, clean water, education, peace, and shelter were identified as the five most essential needs, other needs were also identified as necessary for the children's survival. Based on the results, recommendations were made.